In Her Blood

A 64 year old lady presents 45 minutes after a generalized tonic-clonic seizure which lasted for approximately 5 minutes. She recovered consciousness immediately afterwards, but has remained drowsy and confused since then. All of this was witnessed by her daughter.

She had complained 'feeling unwell' during the preceding 4 days. Her medical history is only significant for mild hypertension well controlled on Amlodipine alone.

A capillary blood glucose and serum electrolytes are within normal parameters, as are serial ECGs, a noncontrast CT of the brain, and a toxicology screen.

However, a complete blood count is significant for a Hb of 8.7 g/dL (normal:11-18), and platelet count of 40,000/mm3 (normal: 150,000-400,000).

A follow up blood film confirms the presence of anemia and thrombocytopenia, while additionally revealing abundant reticulocytes and numerous schistocytes.

Select Relevant Investigations
Renal Functions + Liver Functions

Performed

Blood Urea: 25 mg/dL (0 - 50)
Serum Creatinine: 1.7 mg/dL (0.4 - 1.5)
ALT: 20 IU/L (7-47)
AST: 32 IU/L (10-40)
ALP: 94 IU/L (44-147)
INR: 1.0 (0.9-1.1)
Total Serum Bilirubin: 1.9 mg/dL (0.2-1.2)
Direct Bilirubin: 0.1 mg/dL (0.1-0.4)
Coagulation Profile

Performed

INR: 1.0 (0.9-1.1)
PT: 12 sec (11-13.5)
APTT: 35 sec (30-50)
TT: 11 sec (10-15)
Fibrinogen: 300 mg/dL (150-400)
LDH + Haptoglobin

Performed

Lactate Dehydrogenase (LDH): 490 IU/L (105-333)
Serum Haptoglobin: <10 mg /dL (45-165)
ADAMTS13 Activity Levels

Performed

The results of the ADAMTS13 activity assay will be available in a few hours.

Select Relevant Management
Aspirin
Plasma Exchange
Corticosteroids
Sodium Nitroprusside